Barbara Bates Foundation

Please complete the following registration form to participate in the Barbara Bates Foundation 4th Annual “Walk Where You Live for Breast Cancer Awareness 5K Run/Walk” on Saturday, August 19, 2017 at Douglas Park Field House (1401 S. Sacramento Drive, Chicago, IL 60623). Starting Time: 8:30AM promptly – please arrive between 6:30-7:30AM for t-shirt pick up.

(Note: This registration form is for registrants making online payments only. To register and pay by check or money order, please download and mail this form along with your payment.)

Contact Barbara Bates Designs with questions at 312.808.8091 or email us at kobcwithbbates@yahoo.com.

The Barbara Bates Foundation is a registered 501(c)(3) organization.

Participant Status:

Your Name:

Gender:

Age (on race day), if 12 or under:

Address:

City:

State:

Zip Code:

Phone:

Email:

Please select your team from the list below (or select individual if you are not part of a team):

Note: Teams consist of 20 or more.

Registration Entry Fee: $55.00 per individual (includes processing fee)--12 and under free
(payment will be made on next page)

No refunds.
Registration open through August 12, 2017
Must be registered by August 12, 2017 to be guaranteed a T-shirt (including teams)
Team size consists of 20+
Children ages 12 and under walk FREE with an accompanied adult or guardian
Children ages 12 – 18 require a registration entry fee and parent’s signature

T-Shirt Size - ADULT (select one):

Comments

Terms:

In consideration of this entry being accepted, I hereby for myself, heirs, executors, administrators, waive and release any and all rights and claims for damages I may have against the Barbara Bates Foundation, Mount Sinai Hospital and Chicago Park Districts, race officials, and all sponsors, of all claims or liabilities of any kind arising out of my participation in this event or while traveling to and from. I allow any photographs or materials from this event to be used to publicize this or future Barbara Bates Foundation events.
Check here to confirm that you have read and accepted terms.

Please make sure to read and accept the above Terms. You will be unable to submit this form without checking that you have read and accepted the above terms.

PLEASE NOTE: your registration will not be complete until you’ve paid your Registration Entry Fee. Once you’ve submitted this form, you will be taken to the payment page.